Effectiveness of Treatments for Infantile Colic

Teaching a new mother about infantile colic is one of the primary responsibilities of postpartum nursing. Mustafa Aksam (2006) brings to light that infantile colic (IC) is a problem that effects up to 40% of babies. IC presents itself during the first three months of life and usually has its onset during the second week of life (Aksan, 2006). Many parents and caregivers are frustrated by IC especially when they are unable to control or relieve their baby’s pain and crying. A newly discharged mother is overwhelmed by all the changes in her life. Excessive uncontrolled crying of her baby during the day and night may be an additional trigger for postpartum depression (Roberts, 2004). Nurses should insure that all new mothers receive education about the treatments for infantile colic before discharge from the hospital. The result will be that fewer new mothers will return to the hospital with maternal depression.
The nurse educator will provide information about infantile colic to a new mother. According to Donna Roberts (2004), colic is often defined by “The rule of three”: an infant who is healthy and well nourished but crying “for more than three hours per day, for more than three days per week, and for longer than three weeks.” A colicky infant has attacks of high-pitched screaming in the evening with associated motor behavior such as furrowed brow, flushed face, clenched fists, distended and tense abdomen, and the legs drawn up to the abdomen. The loud cry may persist for several hours. It may be terminated when the infant becomes fatigued, or passes feces or flatus (Roberts, 2004). It is most important for the mother to have reassurance that her baby is healthy and the colic is self-limited with a short term effect unless there are other signs and symptoms of illness (Roberts, 2006). E. Rosenthal (2004) states that infant colic is considered by many as “stressful yet harmless” (Rosenthal, 2004).
According to Donna Roberts (2004), the cause of infantile colic remains unclear, and there is no effective medication that may help to resolve this problem without harming a baby. However, nurses are teaching new mothers several effective treatments that show a significant decrease in the time of infant’s crying episodes (Roberts, 2004).
Mustafa Aksam (2006) discusses the study conducted in Isparta Maternity Hospital in Turkey about the effect of oral hypertonic glucose solution in a treatment of infantile colic. In this study, thirty healthy infants with colic were selected and the double blind study with crossover trial was conducted. Two bottles were prepared for each patient: one bottle with 30% of hypertonic glucose solution used for IV injection and another bottle with distilled water. The same patient used one bottle for four days and then used another bottle for four days. All parents were instructed to give 1 mL of solution before each feeding using medicine droplets. The infants were examined in the clinic repeatedly and the parents described the effect of the last treatment on their infants. The study showed that 64 % of the parents reported an improvement in their infant’s condition while using 30 % of hypertonic glucose solution. However, 36 % of the parents also reported an improvement after using distilled water (Aksan, 2006). No one reported any side effect in this study. Since oral hypertonic glucose solution has a significant effect for the treatment of infantile colic, nurses will recommend it for the new mother as a natural, safe, and cheap therapy.
According to one study reported by P. Kearney (1998), lactase is effective in management of infantile colic. Incomplete lactose absorption in the small intestine provides carbohydrates for bacteria, which are present in the large intestine. Those bacteria metabolize lactose and produce hydrogen that causes infantile colic. Adding a few drops of lactase to the milk formula 24 hours prior to feeding the baby, significantly (95% or 1.14 hr/day) decreases crying time for babies with infantile colic. However, there is no effect of adding lactase to formula during the baby’s feeding. It is possible that stomach acid destroys lactase making it ineffective. The study showed that there was no difference in stool of the babies who had lactase or placebo in milk. Also, there were no side effects reported during this study (Kearney, 1998).
According to Sally Wade (2001), two systematic studies found that the infants fed with soya milk formula have less colic than infants fed with standard milk formula. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75% (Wade, 2001). However another research suggests that infants fed with soya milk formula do not receive important vitamins and proteins that are found in standard milk formula.
Donna Roberts (2004) suggested that herbal mixture containing chamomile, licorice, fennel, and lemon balm is effective in treatment of infantile colic. The mixture should be given to the infant three times a day, 150 mL per dose. However, there is a lack of standardization of strength and dosage, and it is too much for an infant to drink 150 mL of fluid at once. So, the new mother should be cautioned about the use of herbal treatment of infant colic (Roberts, 2004). According to E. Rosenthal (2004), behavioral and environmental modification can decrease infant crying time during the colicky time. Also, E. Rosenthal suggested another herbal mixture called “Gripe Water” which may include cardamom, chamomile, cinnamon, clove, dill, fennel, ginger, lemon ball, licorice, peppermint and yarrow. This product provides relief from flatulence and indigestion, however it has not been scientifically evaluated. Parents should avoid products that are made with sugar and alcohol and are manufactured outside of the US (Rosenthal, 2004).
Donna Roberts (2004) suggested behavior modification treatments for infantile colic. Some infants may reduce or even stop crying if placed near clothes dryer or near the room with a vacuum cleaner turned on that makes “white noise”. “Colic hold” is also suggested, which is a gentle pressure on infant’s abdomen (Roberts, 2004). E. Rosenthal (2004) suggested movements such as gentle rocking motion in a baby swing, in parent’s arms with walking or sitting in a rocking chair, or riding in a car also soothes some babies. Taking a warm bath together not only soothes the baby but also his mother (Rosenthal, 2004).
According to those studies, there are some effective and safe treatments and behavior modifications for infantile colic. If nurses provide the education about infantile colic to the new mothers, it will significantly increase their physical and mental ability to take care of their infants. Nurses prepare mothers to cope with the challenges that their babies will give them. Health care cost will decrease and the baby’s health will increase because mothers will use safe treatments and behavior modifications to treat infantile colic. Fewer mothers will return to the hospital for treatment of post-partum depression as the result of education that nurses will provide to new mothers prior to discharge from the hospital.
Intervention 1. Administering oral glucose hypertonic solutions for infant in treatment of infantile colic.
Disadvantage 1.
Oral glucose hypertonic solution does not affect all infants similarly. According to the study conducted in Isparta Maternity Hospital in Turkey, only 64% of parents reported an improvement in their infant’s condition while using 30% of hypertonic glucose solution. This means that this treatment did not affect positively other 36% of babies (Aksan, 2006). Another study also suggested that oral hypertonic solution does not have the same effect for all newborn babies. In this study only 23 from 36 babies who received one milliliter of oral hypertonic solution experienced relief in pain (Badiee, 2006).
Disadvantage 2.
Another disadvantage is a knowledge deficit. A very small amount of health care workers and parents in US are familiar with this treatment and even a smaller percentage of them uses oral glucose hypertonic solution for treatment of infantile colic. The study about how oral glucose hypertonic solution treats infantile colic was conducted in 2006, in Turkey (Aksan, 2006). There is no evidence that this study has been repeated in US and implemented in US health care system yet.
Intervention 2. Soy milk formula compared with standard milk formula reduces the duration of crying by 50-75%.
Disadvantage 1.
One disadvantage of soy milk formula is affected by socioeconomic status. Soy milk formula is more expensive than cow milk formula. One internet store shows that soy milk formula cost two dollars more than cow milk formula of the same size of can (Diper.com, 2008).
Disadvantage 2.
According to Natalie Reiss, soy milk formula compared to breast milk has another disadvantage. Breast milk reduces the risk of getting infectious and non-infectious diseases in infants. Breast milk also reduces the risk of chronic diseases such as diabetes, cancer, allergies, and asthma in infants. Breast feeding infants also have less risk of becoming overweight compared to formula feeding infants (Reiss, N. 2007).

References


Akcam, M. & Yilmaz, A. (2006, April). Oral hypertonic glucose solution in the treatment of infantile colic. Pediatrics International, 48(2), 125-127. Retrieved February 12, 2008 from CINAHL database.
Badiee, Z. (2006). Pak J Physiol. Oral hypertonic glucose, for analgesia in the premature newborns. 2(2). Retrieved May 5, 2008, from http://pps.org.pk/PJP/2-2/zohrah.pdf
Diapers.com. (2008). Baby Formula/Similac. Retrieved May 5, 2008, from http://www.diapers.com/Shop/SubBrand.aspx?CategoryID=2&CategoryName=Baby+Formula&BrandCode=SM&BrandName=Similac
Kearney, P. Malone, A. Hayes, T. Cole, M. & Hyland, M. (1998, April). A trial of lactase in the management of infant colic. Journal of Human Nutrition and Dietetics, 11, 281-285. Retrieved February 12, 2008 from CINAHL database.
Roberts, D. Ostapchuk, M. & O’Brien, J. (2004, August). Infantile colic. American Family Physician, 70(4), 735-741. Retrieved February 12, 2008 from Proquest database.
Reiss N. (2007, May). New research suggests that breastfeeding babies for at least six months is best. Pediatrics for Parents, 23(5), 2-3. Retrieved May 5, 2008, from Proquest database.
Rosinthal E. (2004, December). Recognizing and treating infant colic. Primary Health Care, 14(10), 45-49. Retrieved February 12, 2008 from CINAHL database.
Wade S. & Kilgour T. (2001, August). Infantile Colic. Clinical Evidence, 323(7310), 437-440. Retrieved January 30, 2008 from Pubmed central database.